1

Table of Contents Cover Page Introduction and Background Behavior to be addressed and rationale Healthy People 2020 Objectives Predisposing Factors Enabling Factors Reinforcing Factors Factors Addressed by Intervention Priority Population Research Question and Determination of Needs Theoretical Basis and Best Practices Goals and Objectives Goals and Objectives Intervention Sequence Session Goals and Objectives Intervention Strategies Intervention Strategies Evaluation Plan Process, Impact, and Outcome Evaluation for Goals and Objectives Resources Plan Overall Projected Budget and Source of Funds Resources and Materials Appendix Resource 1 – Pre- and Post-Test Resource 2 – Game Resource 3 – Try This! Sign Resource 4 – Handout Resource 5 – Survey Resource 6 – Food Log References

2

1 2 5 5 7 8 9 10 14 15 24 26 27 33 36 38 40 41 43 45 47 48 49 50 51

Project Intro, Rationale & Background Target Group: Healthier alternatives for fast food eating among juniors at Daniel High School Nutrition pertaining to fast-food diets among students can greatly affect their overall health. Adolescents and young adults who eat fast-foods are more likely to have growth development problems and later in life develop more diseases and disorders (IJES, 2013). This has much to do with the lack of nutrients in fast-foods. Fast-food options are much more dense in energy (a lot of times giving a full day of caloric intake in just one meal) than they are in providing the necessary nutrients for daily optimal health. In a study conducted by the Journal of the Federation of American Societies for Experimental Biology, it was found that 84% of college students consumed fast-foods, while 54% admitted to eating fast-foods at least once a week (FASEB, 2010). These studies also found that college students would pay more for, but unwilling choose to have more nutrient-dense, healthier options for their meals. Most college students are always on the run, hurrying to the next class or even to work and do not have the time to make a homemade meal. If they could only see what debilitating things it was doing to their body, they might actually give up a little time to concentrate more on health than on hurrying. In another study published in the International Journal of Engineering and Science, all of those 14-18 years of age ate fast-foods; this went down 4.16% once they looked at those aged 19 years (IJES, 2013). This shows that those in high school years are most likely to rely on fast foods, rather than those just going into their college years, which can be quite surprising considering college students are most of the time on an extremely tight budget. This may have to do with the bad food choices that students have at their schools;

3

most people in middle and high school cringe at the thought of eating their cafeteria’s lunch items. Not only is health greatly affected by the food choices in adolescents, but also the amount of money they are spending to buy fast-food meals. Those aged 16-18 years were spending over 60% of their money on fast-food purchases, while only 50% of those aged 17-19 years were spending their money on fast-food purchases (IJES, 2013). Media influences much of the adolescent population into eating fast-foods. Many adolescents will choose fast-foods because of their taste, convenience, ease of acquiring, and out of habit. The 16-18 aged population may be spending more money on fast-foods because it is what they are used to doing from being just out of high school; it may take a couple of years to change a bad habit and start a new healthier one. This could be why there is a 10% decrease in spending’s put toward fast-foods in the 17-19 aged population. It was also stated in this study that those who ate more fast-foods on a regular basis did not think that the foods they were eating had a poor nutritional value, and felt they were just as healthy as their peers. Obesity rates have increased drastically through the years, which increases the risks for many other health problems. Hypertension, adverse lipid concentrations, and type 2 diabetes can result from being obese (Ogden, et al., 2012). Fast foods increase the likelihood for people to think larger portion sizes are better, and in one sitting, the complete daily suggested intake of calories and other energy requirements is met. Starting children off at a young age with fast-foods will make their taste buds continuously crave salts, sugars, and fats because that is what they are used to getting.

4

A study was lead to find how fast-foods affected the likelihood of survival over a span of 15 years. People involved were analyzed by their age, sex, ethnic origin, and education (Pereira, et al., 2005). These people were involved in a longitudinal study. They were analyzed once after 5 years, another after 10 years, then lastly after 15 years. It was found that from the 5115 people who attended the first examination, only 74% of the people would survive the 15 year cohort, and they were actually not the younger population; it seems that the increase of fast-food ingestion (along with decrease in exercise) greatly affects their health and could potentially kill them in the long run. The study also showed that as fast-food ingestion increases, so does insulin resistance and bodyweight. This explains why so many individuals who continue eating fast-food as a main source of “energy” often end up having type 2 diabetes (Pereira, et al., 2005). Healthy People 2020 objectives(s) 

AH-6: Increase the proportion of schools with a school breakfast program



NWS-2: Increase the proportion of schools that offer nutritious foods and beverages outside of school meals



NWS-2.2: Increase the proportion of school districts that require schools to make fruits and vegetables available whenever other food is offered or sold

Predisposing Factors There has been much improvement on labeling of items in fast food industries to let customers know what they are getting. With increased knowledge of a product, people around the world could start making better food choices by knowing what they are getting before they make the purchase. By customers having the knowledge of total calories associated with each product, they could take it upon themselves to decrease their calorie

5

intake and choose the healthier options (Harnack, L. J., French, S. A., Oakes, J. M., Story, M. T., Jeffery, R. W., & Rydell, S. A., 2008). Cultural beliefs have an impact on what people in America eat daily. Acculturation among Asian-Americans and Hispanics has shown that they are more likely to adapt to America’s way of living (fast food consumption, physical inactivity, watching television in spare time, etc.) which as it is seen daily, causes the number of overweight and obese people to increase (Unger, J. B., Reynolds, K., Shakib, S., Spruijt-Metz, D., Sun, P., & Johnson, C. A., 2004). Attitudes about eating fast food often influence whether someone will participate in fast food consumption or not. A study was conducted through the University of Minnesota to analyze the attitudes of individuals that frequently ate at a fast food restaurant. The attitude that seemed to correlate most with fast food consumption was the perceived convenience of it (“I eat at fast food restaurants because they are easy to get to”), (Dave, J. M., An, L. C., Jeffery, R. W., & Ahluwalia, J. S., 2009). Following close behind were the statements: “… because they are quick”, “… because they are inexpensive”, (Dave, J. M., et al., 2009). The other category that scored high in this study was the dislike toward cooking (“I eat at fast food restaurants because I’m too busy to cook”), (Dave J. M., et al., 2009). Not many of the attitudes toward eating fast food had to do with it being fun or socially rewarding, and even less of the attitudes were related with it being unhealthy. This study shows that as many already know, people eat fast food because of its convenience and quickness. People may still know that it is not the healthiest option, but if it is easy and cheap they will go with it anyway.

6

Enabling Factors As the father of Western medicine, Hippocrates, once stated, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health” (Brainy Quote, 2014). Hippocrates made a good point in that if everyone had all of the access of availability that they needed, then everyone in the world would be healthy. Unfortunately, not everyone has a community full of access and availability to all healthy foods. Children’s eating patterns demonstrated that the more items they are exposed to, the broader their taste preference would be (Kirby S., Baranowski T., Reynolds K., Taylor G., Binkley D., 1995). Also, the children eat what is available to them. If parents have chips and candy in the kitchen, the children will eat that. On the other hand, if parents have fruits and vegetables in the kitchen, the child has more availability of healthy foods and will eat that (Kirby S., et al., 1995). It has also been found that among school-aged children, the intake of fruits and vegetables is greater when it is at an easy level to reach, an accessible size (apple wedges, baby carrots, etc.), and readily available (Baranowski T., Cullen K. W., Baranowski J., 1999). The advertisement of the fast food industry has a huge influence on consumption of fast food products. If children are exposed to a lot of television or are on the road a lot and see billboards for McDonald’s, Hardee’s, and KFC they will want to go to those places more than they will want to eat at home, because the companies make them seem so great (Caprio, S., Daniels, S. R., Drewnowski, A., Kaufman, F. R., Palinkas, L. A., Rosenbloom, A. L., & Schwimmer, J. B., 2008). Communities should see this happening and take action. A lot of communities do not have safe environments for children to get outside and play or exercise. If communities were to provide safe places for children to play, run, and get other

7

types of exercise through sports, children would be much more active and be able to burn off the fast food they just ate (Caprio, S., et al., 2008). The National School Lunch Program (NSLP) is made up of about 28 million students (Caprio, S., et al., 2008). Although there are so many students who take part in utilizing this program, it is counteracted in many school systems by vending machines, snack lines, candies and soft drinks being supplied and baked goods (Caprio, S., et al., 2008). By giving these options at a school, it makes it hard for parents to try to enforce healthy eating at home. Also, the school food is sometimes not tasteful to the students, so if they have the option, they would rather grab something from a fast food restaurant. If school policies focused more on supplying nutritious dense foods to their students it may make it easier to promote healthy eating elsewhere. Reinforcing Factors Families play a very important role in the behaviors of their children. Acculturation could possibly reverse the roles of parent and child, resulting in the child leading the parent to adjust to the more “American” way of things (Unger, J. B., et al., 2004). With the child having more control of their life than the parent at this time, the child may react in a way that leads to more television watching, video gaming, etc. Although the family may not be used to the American culture, they will soon come accustomed to everything that happens, and then proceed to enforce those actions on their children’s children, or other family members coming to America. Peers also have a great influence on what people eat. A study was conducted with preschool children that showed children are more likely to eat fruits and vegetables if they see the other children around them eating fruits and vegetables (Birch, L. L., 1980). Also,

8

the foods that teachers choose to have at childcare facilities greatly influence the foods that the children consume (Baranowski T., et al., 1999). If they do not have healthy options, they cannot eat healthy. This is also true for adults; many adults would opt to bring a healthy lunch to work, but from their co-workers influencing them, they all go to a fast-food restaurant instead. Many times a person will have negative comments made to them about their eating habits if they are the “odd man out”, and it will stray them from doing what they know is the best decision, eating a home cooked meal. A family’s primary health care provider should routinely meet with them and discuss the health of their children. If an adult starts off with the proper guidance as a young child, then they will be more likely to adapt those behaviors and continue them with their child as well. The health care provider should discuss the child’s BMI, weight, height and all other factors that influence overall health. They should also discuss behaviors that are common and should be implemented with the child/young adult to be sure that they are receiving proper nutrients as well as expending the amount of energy needed to stay healthy. If more people listened to their practitioners, and cut back on fast-food intake there would not be near as many people obese in the world. Factors Addressed by Intervention At the intrapersonal level we will address the individual knowledge, attitudes, and beliefs of all of the students in the intervention. We will do this by giving the students preand post- tests to analyze their understanding of healthy foods, and their knowledge of calorie dense and nutrient dense foods. This will help us to assess what we need to teach, and incorporate in each session. Another factor that will be addressed will be the interpersonal influences. We will include questions in the pre- and post- tests to evaluate

9

the interpersonal influences over what they choose to eat. These questions will let us know what they choose to eat with friends, as well as what kinds of foods their parents/family member supply for them at home. The organizational level will also be addressed by getting their school to increase healthy food options and decrease calorie dense foods in vending machines and cafeterias. With the community level, we will assess what kind of fast food options the students have in their neighborhood, and whether they have access to a grocery store that supplies healthier food options. Lastly, we will address the public policy level and get their school to enforce healthier options for the students, while also giving them the nutritional information for all foods offered. Priority population: Fast-food intake is most commonly associated with teenagers, and young adults who are always on the go. A lot of times it rarely has to do with their socioeconomic status and/or their demographics, but in this case researchers have found that it actually does. A study was conducted in North Carolina with African Americans in 2004. This study found that demographics did not have as much to do with fast-food consumption as some would imagine. Younger, unmarried, inactive people were more likely to eat fast-foods. Frequency of eating fast-foods was positively associated with obesity and non-use of multivitamins (Satia, J. A., et al., 2004). With this study, it was discovered that frequency of eating fast-foods did not change much among different sex, education, smokers/nonsmokers, or urban versus rural residence. This was only conducted within one state so there could be a slight change in findings if this study were done in multiple different areas in the United States.

10

Individuals with a lower socioeconomic status tend to have a higher rate for obesity. This could have much to do with the fact that those with less income consume more fastfoods, because they cannot afford the healthier options offered at their local grocery stores. A study was conducted in Canada on adolescents to see how much their socioeconomic status affected their weight (Janssen, I., et al., 2006). Those who are obese and are in a lower SES are less likely to perceive themselves to be obese than those who are in a higher SES. The participants in a study relating obesity with unhealthy eating were asked to record their own height and weight to get an accurate BMI for the data. This helped the researchers see how many people were classified as obese and non-obese. Individual-level measures of SES were not related to unhealthy eating and because the path analysis did not find an association between unhealthy eating and obesity (Janssen, I., et al., 2006). In this Canadian study, the poorer neighborhoods tended to have more opportunities for unhealthy eating; this is because there are often many more fast-food restaurants in these areas than there are in areas with a higher SES. Both of these studies help to realize that fast-food intake has a lot to do with the way our health if affected. Demographics do not affect health as much as socioeconomic status does, as we could see in these two different studies. Depending on your socioeconomic status, you could be more or less at risk for obesity if you are more or less wealthy, because of the ease of access to fast-foods. But, if you are generally from the same demographical area you are more likely to have a similar health status as those around you, because you are all exposed to the same food choices. Physical activity also has a great impact on the health issues related to fast-food consumption, but these two aspects were pinpointed to help understand the importance of fast-food disease awareness.

11

Psychosocial factors and personality characteristics effect fast-food eating more than some may actual think. In the study conducted in North Carolina, it was found that fast-food “was associated positively with fair/poor self-rated health, weak/no belief in relationship between diet and cancer, low self-efficacy to eat less fat and more fruits and vegetables, and perceived difficulties of preparing healthy meals and ordering healthy foods” (Satia, J. A., et al., 2004). This explains that many people who are negative about being proactive with nutrition and/or exercise tend to be negative about most other things in their life as well. Also, those who have low self-efficacy may think that there is no hope for them, so they do not see the point in trying to eat healthy if they are just going to stay the same. As Albert Einstein said “Insanity is doing the same thing over and over again and expecting different results,” (Brainy Quote, 2001-2014). Those who continue to eat fastfoods over and over again should not expect to lose any weight or feel any healthier, because these foods do not contain vital amounts of nutrients to live a prosperous life. A study was directed in Australia in 2007 to monitor the personal lifestyle characteristics in relation to a person’s consumption of fast-foods. Fast-food consumption is seen more commonly in those who watch a lot of television, love television, and have a high appreciation for technology (Mohr P., et al., 2007). Those who eat on the run a lot also eat more fast-foods, because it is quicker than having to home-make a meal before the leave. People who live with teenagers in their homes are much more likely to eat fast-foods than those who do not. While, those who are dietary health conscious, love cooking, own a home, are fitness conscious, have an intolerance of advertising, and political complacency are less likely to consume fast-foods (Mohr, P., et al., 2007). This study also showed that

12

there was a great culture shift in the eating habits of the people of Australia, which means age differences have a strong connotation of fast-food consumption. It seems that from the results of these two studies, psychosocial and personality factors have much to do with fast-food consumption. Beliefs, attitudes, values, and knowledge affect whether or not people eat fast-food regularly more so than their demographics and SES. Concluding from the studies, there are so many different influences on a person’s eating habits. From personal beliefs about healthy eating, knowledge on what is good and bad for you, their socioeconomic status contributing to more fast-food connections, to having personal reasons such as feeling that no matter what you eat, you will always be the same, and the list goes on. It is important to understand the constructs associated with this behavior as it is very common among our population in the world today; fast-food industries are blossoming every single day to better your availability to them. We will access the children eating fast foods through schools by targeting what they are serving for breakfast, lunch, and snacks. Many schools feed meals that hardly seem like they should be food, so by training cafeteria staff to cook healthier this will provide the students with meals they will actually want to eat, so that they will not leave during their lunch period to get fast food. Also, by stocking vending machines with healthier options (granola bars instead of candy bars, nuts instead of M&Ms, pita chips instead of potato chips, etc.) students will have better choices of snacks so that they may improve their health outside of their home environment. In their home, parents have a huge influence on what children are eating so by educating the parents we can teach them to buy healthier foods. We can also provide

13

information on what foods they could substitute unhealthy/fast foods for so that they may give the child a more nutrient dense diet. By targeting these two areas, we can ensure a healthier diet among children and assist in prevention of early onset diabetes, obesity, and other health issues. Needs Assessment and Research Questions To determine the needs of the priority population we will determine the prevalence of fast food intake among adolescents. We will also determine the prevalence of obesity and Type II diabetes in the school’s county. From this information, we will see if it is beneficial to implement our intervention. Previous studies show that snacking patterns among adolescents aged 12-19 years affected their health by providing 23% of daily calories, 31% of total sugars, and lesser portions of most vitamins and minerals (NHANES, 2005-2006). This study also showed that adolescents who had at least 4 snacks in a day consumed as much as 1.5 times more calories than those who reported having no snacks. Another series of focus group discussions were expedited in Georgia at the Children’s Healthcare of Atlanta showed that the youth population did not understand the connection between lifestyle choices and future illnesses (Sylvetsky, A., et al.). If the youth in this area were educated on proper nutritional requirements and alternatives to junk food, they would be able to lessen their chances of becoming obese.

14

Research questions from Harvard Prevention Research Center that will be implemented in our program 

Is price a factor when deciding where to go for food? o If yes, if prices were equal for a meal would you choose a restaurant with predominately healthy foods or restaurants with predominately unhealthy foods?



Is price a factor for choosing a healthier meal?



How often does one eat fast food? o In a typical week how many meals do you eat at a fast food restaurant?



What are young people’s opinions on regulating healthy foods in schools?



Some of our state officials would like to regulate the sugary/high fat foods that are placed in vending machines, a la carte lines and the school lunch so that the school nutrition environment is healthier. Do you agree with this?

Theoretical Basis #1 A study was conducted in Iran on high school students identifying factors that relate to fast food consumption. The theory used to demonstrate the relationships of behavioral intentions and actions was the Theory of Planned Behavior. Students were recruited by cluster randomized sampling and cross-sectional data was collected (9 classes from boys’ schools and 9 classes from girls’ schools) (Sharifirad, G., Yarmohammadi, P., Azadbakht, L., Morowatisharifabad, M. A., and Hassanzadeh, A., 2013). A total of 600 questionnaires were given out, and 521 were returned (Sharifirad, G., et al., 2013). Students answered a questionnaire that assessed different variables of the TPB model including: attitude, subjective norms, perceived behavior control (PBC), and two additional variables: past

15

behavior, and actual behavior control (ABC) (Sharifirad, G., et al., 2013). Through this behavior theory the analysts found that the TPB model could be very useful in planning interventions to reduce consumption of fast foods (Sharifirad, G., et al., 2013). The constructs as mentioned above were examined on a 5-point scale, 1 = strongly disagree and 5 = strongly agree. The first construct assessed was attitude; statements like “fast food tastes good” and “eating fast food frequently is good for my health” were used to get a score (Sharifirad, G., et al., 2013). Next, subjective norm was assessed and defined by a perceived social pressure to perform behavior, and was measured with four items (Sharifirad, G., et al., 2013). One statement measured here was, “Most people who are important to me think that I should eat fast food regularly”. PBC included statements such as “It would be impossible for me not to eat fast food regularly during the next month”, and was measured using four items (Sharifirad, G., et al., 2013). ABC was measured by two items, one stating “Where I live, I have no access to fast-food outlets”. The two statements used regarding past behavior were, “On average, how often do you eat fast food?” and “In a week, how many times have you eaten fast food?”; these were rated differently than the others (a scale was used from 0 = never to 7 = more than once per day (Sharifirad, G., et al., 2013). Behavior intention was the last construct assessed in this study, and was measured through three items. One of which included, “Given my lifestyle, it is likely that I will eat fast food regularly over the next four weeks”, (Sharifirad, G., et al., 2013). Through the utilization of each of these constructs the researchers get a good idea of the importance of fast food in each of the individual diets of the participants. This study is very informative of how different variables can affect behavior in many ways. It is a good indicator of how much fast food is consumed in the adolescent aged

16

population in Iran. Although, it gives a good indicator of high school aged students, a different study would need to be conducted to generate a general outlook on the overall population, because adolescents are seen to consume more fast food than anyone else during this part of their life (Sharifirad, G., et al., 2013). Through this study, subjective norms and past behavior were found to be the best predictors of fast food consumption (Sharifirad, G., et al., 2013). The conductors of this study deem it necessary to examine a model’s usefulness in each individual population, because it could have different variable controls for example, developed and developing countries. Theoretical Basis #2 In 2013, a graduate from Arizona State University led a psychological study where an association was found between the Moral Foundations Theory, ethical concern and fast food consumption (Martinelli, S. (2013). The two measures that were used in this psychological study were the Moral Foundations Questionnaire (MFQ) and the Ethical Concern in food choice (EC). There were 739 primarily female participants who completed both surveys online (Martinelli, S. (2013). The study used the Moral Foundations Theory, which “expands on previous morality measures that focused primarily on fixed ideas of harm and fairness which are thought to be an incomplete description of moral thinking across cultures” (Martinelli, S. (2013). The primary aim with this study was to find out if psychological morality has any relation to the types/values of foods that people put into their body. The constructs that are measured through the MFQ are harm/care, fairness/reciprocity, ingroup/loyalty, authority/respect, and purity/sanctity, but only two of these were used in this study, harm/care and purity/sanctity (Martinelli, S. (2013). The

17

harm/care construct is associated with those that see suffering in humans or animals and will place more significance on actions that help to reduce the suffering (Martinelli, S. (2013). This has to do with those who are vegetarian or vegan, these people do not want animals to suffer to so that they can have food on the table so they opt for more fruits and vegetables, and can be healthier than some of those who choose to eat meat. The purity/sanctity construct is associated with maintaining the purity of one’s body by choosing items that have positive impacts on the body (Martinelli, S. (2013). This too can be related with the avoidance of meat eating, as well as more “clean eating” (organic items). It was not stated as to why only two of these constructs were measured, but it could have been due to the overall intention this study had; to find if morality and purity values were issued with healthier, purer, more organic eating habits. The findings with this study showed that the MFQ scores were associated with the frequency of eating fast-foods (Martinelli, S. (2013). Those who believe that an item will give them the benefits they need in their body will be more likely to eat that certain product, as where those who do not value the benefits that food gives them will be more likely to eat fast-food items. The MFQ’s purity/sanctity foundation and EC’s religion subscale were the most highly correlated, which showed that moral intuitions could be associated with eating decision making (Martinelli, S. (2013). The ideas that people have in their minds psychologically impact their actions and behaviors towards eating habits. Those with a cleaner outlook will be more apt to eat healthier food items, and those who have a carefree attitude will more likely eat whatever is put in front of them as long as it fills them up.

18

Each of these studies gives a framework that contributes to frequency of fast food consumption, and explains the importance of what funds each person’s behavior. Everything that takes place leading up to someone’s actions is very important to predict the outcome of their actions. A participant’s surroundings contribute to their actions greatly; if someone does not have access to fast food, it would be hard for them to incorporate it into their everyday diet. Although, if someone lives in an area where fast food is readily available at every street and others within their immediate family think consuming it has no negative affect on health, then they will definitely be more likely to consume fast foods on a regular basis. Same goes for a person’s beliefs; if someone believes that they need to have a pure diet and eat only the “clean” items, they will not be found in a fast food restaurant. Also, those who do not find it humanitarian to kill and eat meat, will not go to fast food restaurants either, because most of the foods served in these places have some kind of meat in all of their products. Eating purer, more harmless meals, and being well educated will lead to healthier diets overall, and will decrease the amount of people that rely on fast food industries every day. Best Practices/Model Intervention for Fast Food Consumption Fast food consumption needs to be decreased drastically in order for people to live longer healthier lives. With so many unhealthy food options available at such an inexpensive price, something has to be done to bring awareness and help people stop consuming fast food every day. Fast food is even seen as being very addictive in some studies (K Garber, A., & H Lustig, R., 2011). People will binge; consume a large amount of fast food items at one sitting, and think that this is better than eating it every day. It is not in any way better, because all of the calories and nutritional substances are still the same,

19

no matter how quickly or slowly they are taken in. Some people even crave fast foods and go through somewhat of a withdrawal if they go too long without it (K Garber, A., & H Lustig, R., 2011). Those craving fast food are looking for some kind of food to send their taste buds on a rollercoaster, but instead by eating other foods, find that they are not as satisfied. There was a study conducted to improve nutritional intake with fat (% energy) and consumption of fruits and vegetables (servings per day) (Kristal, A. R., Glanz, K., Curry, S. J., & Patterson, R. E., 1999). There were three stages of change that the participants went through; low-fat diets, high-fiber diets, and diets high in fruits and vegetables (Kristal, A. R., et al., 1999). By slowly changing their type of diet, the participants will have an easier transition into a healthier lifestyle. The progression was monitored during through three different stages: pre-action, action, and maintenance (Kristal, A. R., et al., 1999). During pre-action there was not much of an improvement, but during the action stage there was a lot of improvement with both (fat and fruits/vegetables). This improvement decreased during the maintenance stage, most likely because it was up to the participant to keep up with the new dietary plan. As the researchers had a follow-up session with the participants, their scores actually showed even more improvement overall (Kristal, A. R., et al., 1999). This study is a good way to implement dietary changes to increase healthy eating everywhere; by taking small steps along the way people will have a better outcome than if they tried to change everything in their diet all at once. An intervention plan that would be successful in helping people stop consuming so much fast food would have to contain strict guidelines, because fast food is available almost anywhere you look. It is not just going through a drive-thru, but it also includes eating out

20

at restaurants and grabbing something at a gas station during a road trip. A person looking to change their diet will first need to have the knowledge to do so. The first step in the intervention will be to assess the person’s eating habits for one month. By this time there will be a good idea of how much fast food is consumed on a normal basis with this person. Considering the intake each week, the first goal will be set (decrease fast food intake to <5 times per week), then this can continually be decreased for the following weeks (decrease fast food intake to <4 times per week, <3 times per week, etc.). With these small steps, it will be easier for the person to stay on track. If they consume more fast food than they do other foods, the starting number may need to increase just a bit to make sure the change is not too drastic to begin with. The next goal would be to decrease fast food consumption to <5 times per two weeks, then <4 times per two weeks, etc. This is going to increase the awareness of the person, while greatly improving their nutritional intake. This could go on by increasing the time increments to better the person’s diet for a full year; although they may stop eating fast foods, they may still eat unhealthy food items at home, filled with empty calories. If this happens, the person will need to become more knowledgeable of what is nutrient dense and what is not so that they have a better understanding and continue eating healthy. Keeping a food log each week will be very important in staying on track with this strict diet change, and will result in better overall outcomes because of the increased awareness of what is being consumed. Predisposing factors, such as education about fast food is the best way to get someone on the right track to changing their lifestyle; once someone sees the negative impacts fast food has on their life, it will give them even more of an incentive to quit eating

21

it. Also, by educating people on the great benefits they will get from eating healthier, nutrient rich foods, they may be enticed enough to further their knowledge and try even harder to continue their path to a healthier lifestyle. This could include cutting out all empty calories, limiting greasy foods, as well as increasing their physical activity to reduce cardiovascular disease. Enabling factors, such as access and availability to healthier alternatives contribute to the ease of the dietary change. Someone who has easier access to a grocery store with healthier food options than a fast food drive-thru will experience a less stressful change than that of someone who has to travel further to get to a grocery store that supplies healthier foods. Also, the foods that are supplied in a person’s workplace or school play a large role in the decision making process. The easier the access of healthier foods, the more likely someone is to buy and eat them. Lastly, reinforcing factors play a very important role in eating habits. Family, peers, coworkers, friends, and others you come in contact with will have a strong impact on the way a person perceives different food items. If a person has family, friends, etc. who eat out all the time, those people will probably not be the best to help with the dietary change they may be going through. On the other hand, if a person has family, friends, etc. that are very conscious of their health and choose healthier food options for themselves; they will be more apt to encourage them to move forward with the dietary change. The levels of the socio-ecological model that would be most effective in helping with a dietary change would be intrapersonal, interpersonal, community, and physical environment. For an intervention to be successful, a person has to have internal motivation first and adopt the mindset that they want to better their health. By motivating

22

oneself it will be easier for them to continue on the path of healthier living to increase their lifespan. If the person does not believe in himself/herself then the intervention will go nowhere. During the intervention, the person will get tips on how to stay on track and believe in themselves before letting others know what their plan of action is. If they understand their final goal for the end, it will be easier for them to cut out fast foods and initiate healthier foods. Once the healthier foods are introduced, the goal will increase week by week so that they slowly cut down on the fast foods they consume while replacing them with healthier items. Next, the interpersonal level will be looked at; the person’s socialization group will be important in the change process. Coworkers, peers, friends, and family need to understand that the person is serious about making a change and strongly encourage them to do so. Sometimes those people will try and stray the person off of their goal, but the person needs to be strong enough to know that they can overcome the obstacles along the way. A lot of times those people are only trying to stray them away because they are jealous of the amazing outcomes that the person is getting from the new lifestyle he/she has adopted. If the person is strong on the intrapersonal level it will make being strong at the interpersonal level a much smoother process. Being able to stand up for one’s own decision will help the person continue with the healthier lifestyle. The community that the person lives in will greatly impact the growth process, because many times communities have an abundance of fast food restaurants in the area that make it much easier to consume their product than to go home and make a cooked meal for themselves. On the other hand, some communities encourage healthier lifestyles by providing local farmers’ markets, easier access to grocery stores, and safe areas to

23

exercise. Having these options would be ideal, but are not always probable. Again, the person needs to learn to overcome the obstacles that may lie in his/her way through their process of change, and be sure they can have a plan to continue eating healthy while reducing their risk of getting pulled back into the fast food diet. Rationale and goals that guide intervention Consuming fast food on a regular basis can cause you to have extreme health problems such as lack of nutrients, increase in obesity risk, hypertension, and decreasing alertness. It is important to educate adolescents and young adults on the harmful effects of fast food consumption so they are able to choose healthier options and decrease their likelihood of suffering from these health issues. By monitoring fast food consumption with each subject keeping a food log, we will be able to get a better understanding of how much fast food is being consumed on a weekly basis. From this information, we will work with them to control consumption of fast food, while helping to adjust their meals to improve nutritional intake. We will also teach the group to substitute their fast food meals with healthier and more flavorful options so that they may decrease their risks for health problems later in life. The program that will implement these changes will be called “HATE Fast Food”, this will stand for “Healthy Alternative To Eating Fast Food”.

24

Intervention goal(s) and objective(s)

Learning

•Students will be able to identify what foods are nutrient dense and what foods are not with a success rate of 80% at the end of the intervention by calculating how many they got correct and how many they got wrong during the classroom game

Behavior

•First week: decrease fast food consumption to <5 times •Second week: decrease fast food consumption to <4 times •Third week: decrease fast food consumpiton to <3 times •Fourth week: decrease fast food consumption to <2 times •Fifth week: decrease fast food consumption to <1 time

Behavior

•Students will increase their consumption of nutrient dense foods by incorporating at least 3 of them in their diet per day after completing their first food log

Behavior

•Students will decrease their high calorie/low nutrient food consumption by 50% at the end of the intervention by comparing the first and second food journal on the amount of times they ate high calorie/low nutrient food

Environmental

•Students will have a decrease in high calorie/low nutrient foods offered in vending machines and in cafeterias by the end of the intervention

Outcome

•By the 3rd week, students will maintain their new eating habits by consuming fast food <3 times per week after the intervention is complete

Process

•We will evaluate the students' participation, attendance, and staff performance by taking attendance at each session, and giving pre- and post- tests to evaluate their learning

25

Sequence of intervention Session 1 of the intervention will include handing out food logs to adolescents during their designated book pick up time. During this time, we will have a brief talk about how to fill out the food log, and inform them of the program they will be involved in. After 3 weeks we will collect everyone’s food log and analyze the information we are given. This gives the students an ample amount of time to have variance in their diet. We will take notes on how many times fast food was consumed each week, while categorizing the results into their designated classrooms which will be determined by the amount of fast food they consumed recorded in their food journals (from heavily consumed, moderately consumed, and lightly consumed). Through this session we will get an idea of what they perceive the subjective norms to be. The subjective norms will also be measured through pre- and post- tests so that we may see what their friends and family tend to eat that may influence their eating habits. Session 2 of the intervention will take place in the classroom for each of the groups who filled out food logs. It will involve handing back the completed food logs with comments in them on how to improve their weekly eating habits Depending on how much fast food was consumed within each classroom, we will address the main issues associated with their eating habits. For the group that heavily consumed fast food (4-5 times per week), we will address how to take small steps to better eating while educating them on the difference between nutrient dense and calorie dense foods. For the group who had moderate fast food consumption (2-3 times per week), we will introduce them to more nutritional, tasteful foods by teaching them to cook their own meals and choose healthier alternatives when eating out. We will schedule an event with CU Chefs so that the students

26

may learn how to cook healthier for themselves. For the group who sparingly consumed fast food (<2 times per week), we will help to reinforce their habits and discuss ways to continue eating healthy. This will give us an understanding of what their past behaviors consisted of before getting the knowledge about the risks of fast food consumption Session 3 will include handing out new food logs for the students to complete after the classes have been conducted. We will have them log their food intake for another 3 weeks and then evaluate how their eating habits have changed. If they improved their diet, we will surprise them with a free “HATE Fast Food” t-shirt. But, if there is not much change they will receive a free “HATE Fast Food” sticker. This part of the intervention will help us to know how much perceived behavioral control they have. Their post-test results will give us an idea of how their perceived behavioral control has changed so that we may see how much control they feel they have over their own food intake. The overall goal will be to increase knowledge, change behaviors, and change attitudes towards eating fast food. By implementing these changes this will increase selfefficacy and give the students a greater understanding of how important it is to eat healthy. Session Goals and Objectives Introduction Session: 3 weeks before the sessions start Goals: To educate the students and teachers on the intervention plan and program they will be involved in. Greeting and check-in (10 minutes): Hello. We are H.A.T.E Fast Food. We are going to spend a few weeks with you to tell you about the different types of foods and which foods will keep you healthy. Today, for our first meeting you will receive a food journal. I ask that you write down what you eat for every

27

meal each day for 3 weeks. We will then collect your journals and review them, add comments, and split everyone into groups. If anyone has questions, feel free to approach any of the H.A.T.E. Fast Food team. *Pass out food logs* See resource 6 *Give pre-test* See resource 1 Session 1: Collect food journals at all school entrances Goal: For the staff to analyze each student’s food journal and place them in the correct groups for intervention. From their results in the food logs, we will be able to know exactly how much fast food they consume daily and weekly so that we may adjust programs to benefit each child. This will also give the child awareness of what they are putting in their body through each meal. Session 2: Return food logs with comments so that they may have the knowledge of how to change their diets and decrease their fast food consumption. Goal: Depending on their level of fast food consumption, the child will be educated on how to change their behaviors to better their diet, whether it is through cooking or just choosing healthier options when eating out. *Split students into designated classrooms* 

Group 1 in “Classroom McDonald’s” o This group will consist of the children that consumed the most fast food (4-5 times per week) o This session will be led and monitored by 2 proctors

28

o We will educate them on how to take small steps in changing their eating habits by helping them understand the difference between nutrient dense and calorie dense foods o Goal: Have the students practice sorting food items into “healthy” and “unhealthy” food baskets in hopes to get their success rate to 80% by the end of the intervention o Script to be followed: Today we are going to play buzz game. For this game, we will split into two groups. The person that hits the buzzer first gets to answer first. You must identify the food on the screen as nutrient dense or calorie dense. *Play game* See resource 2 Now that we know the difference between nutrient and calorie dense foods, we will discuss how to make small changes that will increase healthy choices. *Give Handout 1* See resource 3 Now you will get a new food journal to fill out for the next three weeks. Fill the journal out as you did before; remember what you learned about today and try to make improvements in your eating choices. We will collect the journals in 3 weeks and see how you have progressed. Thank you for your participation thus far. 

Group 2 in “Classroom Moe’s Southwest Grill” o This group will consist of the children that had moderate fast food consumption (2-3 times per week) o This group will be led and monitored by 2 proctors o We will teach them how to identify more nutritional foods when eating out

29

o CU Chefs will have an event to teach the children how to cook healthier meals for themselves and show them that it is possible to have tasteful, healthy foods o Goal: Students will decrease their high calorie/low nutrient food consumption by 50% after this session o Script to be followed: Today we have CU Chef here to show us how to make easy, but healthy meals for ourselves. *CU Chef demonstration* Thank you CU Chef! Now we will talk about how to eat healthy when dining out. *Give Handout 2* See resource 4 Now you will get a new food journal to fill out for the next three weeks. Fill the journal out as you did before; remember what you learned about today and try to make improvements. We will collect the journals in 3 weeks and see how you have progressed. Thank you for your participation thus far. 

Group 3 in “Classroom Whole Foods” o This group will consist of the children that had the least amount of fast food consumed (<2 times per week) o This group will be led and monitored by 2 proctors o We will reinforce their good eating habits and discuss ways to continue eating healthy o The class will develop a meal plan for a day that consists of all healthy options o They will also share their personal experiences on how they continue eating healthy

30

o Goal: This group should be able to incorporate 2 healthy meals into their diet per day after this intervention; this will be monitored by their food log o Script to be followed: Today we are going to discuss our eating habits and how to continue eating healthy, also we will be working with CU Chef to make daily meal plans. Now we are going to talk about how we like to eat healthy? *Discussion* What are ways to continue eating healthy? Even when dining out? *Discussion* Let me welcome CU Chef to the stage. *CU Chef demonstration; explaining easy meals to make and helping students create healthy meals plans.* Thank you CU Chef. Now you will get a new food journal to fill out for the next three weeks. Fill the journal out as you did before; remember what you learned about today and try to make improvements. We will collect the journals in 3 weeks and see how you have progressed. Thank you for your participation thus far. *After three weeks, collect food log journals at all entrances of school* Session 3: We will reinforce their healthy changes that they have made through eating habits in hopes to prolong their healthful lifestyle. Goal: Use positive reinforcement by giving t-shirts and stickers in hopes to continue their healthy eating habits.

31

Script to be followed: Hello and welcome back. First off we would like to thank you for willing to participate in our program. We have a survey for you to take to rate this program, tell us how we could improve, and what your favorite activity was. *Take survey and post-test* See resource 5 and 1 *Handout Packet* Will vary with each student based on their needs We have looked over all the food logs and determined everyone’s progress. The packet you received will have information on your progress and how to further improve healthy eating. Once again, thank you for your participation and remember to eat healthy and find alternatives. H.A.T.E. Fast Food! Session 4: After two months return to the school and evaluate the students’ food consumption by having them fill out a food journal for a week, so that we know if they decreased their fast food consumption. Goal: To see if the students maintained eating fast food <3 times per week. *Hand out food logs* Session 5: We will return to collect the journals at all entrances of the school. Goal: For staff to evaluate and analyze their intervention program, and make the changes necessary for future successes.

32

Intervention Strategies Health Communication Strategies will be used to inform and influence the students on how to improve their eating habits. Through this strategy we will raise their awareness of the risks of fast food consumption, as well as the benefits of not consuming it. We will work to change their way of thinking so that they get excited about eating healthier food items, rather than getting excited about a trip to McDonald’s. After we have gotten the students to believe eating healthy foods is much better for them, we will work on getting healthy eating to be the norm for their population. We will communicate healthy eating to the students through a wide array of channels. First and foremost, we will have the intervention sessions with each classroom to focus on the individual needs of certain students. These sessions will last for 1.5 hours and we will have a presenter lead in by giving statistical facts about how fast food affects your health, and increases your risks for health complications. There will be signs put up in their classrooms that will encourage healthy lifestyles, and discourage consumption of fast foods. For the signs, reading level, maturation, and understanding will be taken into consideration. We will consider these different areas by obtaining information from the school regarding the classroom average reading level. Also, there will be weekly text messages sent out to the whole group of students inspiring them to stick with their healthy choices by focusing on healthy food alternatives for breakfasts, lunches, dinners, desserts, and snacks. We will have a group of volunteers available to answer any questions students may have throughout the intervention through a calling hotline, or if the students prefer, text message communication.

33

Health Education Strategies will also be used for this intervention. The sessions within this intervention are tailored for the specific group of students whether they consume fast food regularly, occasionally, or rarely. Depending on which group the student is in, their program will be adjusted to target their educational needs. As soon as the groups are split into their designated classrooms, everyone will introduce themselves and get to know each other a little better so that they can be comfortable talking with one another, then the intervention sessions will begin. At this time, we will get information on any specific food allergies, or special diets the students may be on, so that we may gear their meal options to suffice. The students will be taught the basics between unhealthy/fast food choices and healthier/nutritious foods, and be given the knowledge so that they may differentiate the two. Depending on the level of understanding, the students will have a cooking class that will teach them how to make healthy foods taste better so that they are more appealing. This will encourage the students to be creative and try new things as well as widen their horizon for food options in the future once they have the basics accomplished. Using the education strategy, we will be able to increase the students’ self-efficacy so they know they have the ability to succeed with a healthier lifestyle; they just need to be given the education and training to do so. For the students who already eat healthy foods, and rarely consume fast foods, we will encourage them to come up with new ideas for meal options. They will then work with CU Chefs in order to learn how to create the new meal ideas so that they will be able to recreate these items at home. After each of the sessions, we will give out a survey for the students to complete that will let them give us feedback on

34

the session as a whole. This will help us to know what will need improvement for the future, as well as give us an insight of what activities they enjoyed and did not enjoy. Environmental Change Strategies will also be used for this intervention so that we may remove the option of fast food within the school. We will hold a meeting for 1.5 hours with the school faculty prior to the intervention and inform them of the process we are going to be undertaking. To start the session off, the faculty will be given a presentation on how detrimental fast food is to the students’ health, and that they can help to keep their students healthier by removing certain items from snack machines and cafeteria lines. We will give the faculty ideas on what to replace the bad foods in the snack machine with, so that the students may still have snacks throughout the day if they need them, but they will be much healthier. After the presentation, there will be time for questions regarding the issue and we will listen to any ideas from faculty on how to help. If the school removes candy bars and chips, they can replace the items with granola bars and nuts. By removing the soft drinks that are currently available, they can replace them with green tea, Gatorade, or infused water. The school can replace M&Ms and Skittles by giving the students the choice of chocolate covered almonds and raisins. There are many options available for the school, but the main idea here is to inform the faculty that they play an important role in improving the students’ overall health. At the end of this session, we will get feedback from the faculty and see who is willing to put their foot forward and help make this idea come into action. We will collect names and numbers from those who will participate in making the change happen. At this point, we will also get an idea of what they are going to do to help, and schedule follow-up meetings to make sure things stay on track. For those not wanting to participate in the change, we will

35

encourage them to at least be active and encourage the students to gear their lives towards a healthier lifestyle in order to live longer, more rewarding lives. Process, impact, and outcome evaluation plans for goals and objectives o Decrease fast food consumption per week (behavioral) 

First week decrease to <5 times, second week decrease to <4 times, etc. 

Process – 2nd food journal turn in, to see if they increased healthy food intake any



Impact – analyze the difference between 1st and 2nd food journals to see if there was a difference in food consumption



Outcome – after two months return to the school and evaluate the students’ food consumption by having them fill out a food journal for a week, so that we know if they decreased their fast food consumption

o Increase awareness of nutrient dense foods (learning) 

Students will be able to identify what foods are nutrient dense and what foods are not with a success rate of 80% at the end of the intervention 

Process – testing them with the PowerPoint game to see the percent of correct answers



Impact – look at pre-quiz distributed and see if there were changes made from then to the PowerPoint game



Outcome – look at the results from the post-quiz to compare it to the prequiz

o Increase consumption of nutrient dense foods (behavioral)

36



Students will increase their consumption of nutrient dense foods by incorporating at least 3 of these in their diet per day after completing their first food log 

Process – looking at their 2nd journal to see if they consumed nutrient dense foods or continued their regular diet



Impact – analyze changes in the 1st food journal to the 2nd food journal



Outcome – look at 2nd food journal and evaluate the changes from it when we return after two months and have them complete a food journal one week

o Decrease unhealthy foods offered in schools (environmental) 

Students will have a 50% decrease in high calorie/low nutrient foods offered in vending machines and in cafeterias by the end of the intervention 

Process – test to see if the students know how to eat “healthier” fast foods



Impact – seeing if healthy foods in the vending machines decrease fast food consumption



Outcome – evaluating changes in what foods were offered in the vending machines prior to intervention and after the intervention

o Decrease unhealthy foods consumed while in school (environmental) 

Students will decrease their high calorie/low nutrient food consumption by 50% at the end of the intervention 

Process – see if students know the difference between high calorie and high nutrient foods



Impact – looking at their food journals to see if they decreased their fast food consumption during school hours

37



Outcome – after the intervention return to the school to see if healthy foods are still available in the vending machines, and evaluate their consumption of healthy foods from the vending machines

o Maintaining eating habits (outcome) 

By the 3rd week, they will maintain their new eating habits of consuming fast food <3 times per week. 

Process – see if their healthy eating has increased within the 10 weeks of the intervention



Impact – after two months of leaving the students, we will return and see if the students continued the healthy eating habits



Outcome –

o During the intervention we will evaluate the students’ participation, attendance, and staff performance (process) 

We will take attendance at each session, and give pre- and post- tests to evaluate their learning. 

Process – taking attendance at each session



Impact – the changes in pre- and post- tests



Outcome – the survey at the end of the intervention will let us know how to change the intervention for the future

Resources Plan 

Staffing and volunteer needs: We will provide at least six proctors, so that there are two per classroom during the

intervention sessions. There will be an extra six team members used for program and

38

session help (passing out folders, answering questions, assisting proctors, etc.). The intervention will need teachers at the school that are willing to give up a portion of their day for our intervention sessions. Also, there will need to be teachers that can encourage students to eat healthier foods, rather than fast food items so that they have some outside motivation other than just hearing it from the intervention leaders. Once the teachers have been informed of the intervention process, we will need to have some of them volunteer to assist in removing the unhealthy food items from snack/drink machines in the school building. Lastly, we will need to make sure that CU Chefs is willing to volunteer their time and effort in order to help the students learn more about healthy eating, as well as new ways to prepare healthier meals by themselves. 

Space, equipment, and supply needs: For our sessions we will need three classrooms that each of the groups will be split

up into. Food journals will be needed for each student to fill out throughout the intervention. A projector and iClickers for the classroom for the activity that involves students choosing which foods are nutrient dense and which foods are calorie dense will be needed, if not already available. The cafeteria at the school or a traveling stove will be necessary so that CU Chefs will be able to adequately teach the students how to prepare healthy meals. For first and last sessions, we will need to have an auditorium available so that we may speak to the students as a whole. For students, we will have T-shirts and stickers as rewards to hand out depending on their achievement level. At the end of the intervention, we will need to have folders to give with their personal achievements and further recommendations.

39



Overall projected budget and source of funds:

Item Requested Program Supplies Food logs Folders Paper for quizzes Pencils T-shirts Stickers Handouts & Promotional materials (copy paper & ink) Space Needs Auditorium iClickers Classrooms Conference room CU Chefs Needs Portable stove Cooking utensils Pots and pans Plates Food Water supply Cups TOTAL SUPPLIES

Type

Evaluation Education Evaluation & Education Evaluation Reinforcement Reinforcement Recruitment, Education & Evaluation Access Access Access Access Education & Access Education Education Education Education Education & Access Education

Number Needed

Unit Cost

Amount Requested

400 400

$1 $1

$408 $420

400

$1

$144

400 412 300 1 pack (copy paper) 2 (ink)

$1 $5.50 $4 $45.99 (paper) $27.95 (black) $20.95 (color)

$432 $2,266 $900

1 1 presenter kit 400 student 3 1

$0 $66.50 $5 $0 $0

Donated

1

$125

$125

15 7 300 30

$3 $10 $.05 $5 - $15

400 8oz cups

N/A

400

$.07

$45 $70 $15 $150 - $450 Negotiate with school $28 $7,597.39

40

$94.89

$2,199.50 Donated Donated

Resource and Materials 

Reference list and addresses: o Dollar Tree 

Store #1073 641 Hwy 28 Bypass Anderson, SC 29624

o Sam’s Club 

3812 Liberty Hwy Store #6 Anderson, SC 29621

o iClicker 

www1.iclicker.com/rentals/

o Inksupply.com 

www.inksupply.com

o CustomInk 

www.customink.com

o Quill.com          

www.quill.com

Program logic model:

Inputs: Money Supplies CU Chefs Team members Volunteers School space Teachers Student participation

Outputs:  Trained proctors to lead sessions  PPT game  Handouts  CU Chef Program  Flyers for classrooms

Short-term Outcomes:  Knowing the difference between nutrient and calorie dense  Expanding healthy palate  Meal planning

41

Mid-term Outcomes:  Increase intake of healthy alternatives  School serving healthy foods

Long-term Outcomes:  Continuous consumption of healthy foods  Continuous decrease of fast food consumption



Sample of handouts, games, etc. to be used: o Attached…

42

Pre & Post Test 1. Gender? a. Male b. Female 2. With whom do you typically eat meals? a. Whole Family b. Some members of family c. Friends d. Alone 3. Are you concerned with your health at this time? a. Yes b. No 4. Are you concerned that your eating habits with determine your health in the future? a. Yes b. No 5. How would you describe you economic situation at home? a. Satisfied b. Comfortable c. Deprived 6. How much fast food can you estimate that you ate in the last week? a. 4-5 times a week b. 2-3 times a week c. Less than 2 times a week Answer the following questions by choosing “1” completely agree, “2” somewhat agree, “3” somewhat disagree, or “4” completely disagree. 7. If my parents bring home fast food, I will eat it. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 8. If my friends bring over fast food to eat, I will eat it. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 9. My family members would like the amount of fast food I consume. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 10. My friends would like the amount of fast food I consume. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree

43

11. The amount of fast food restaurants near me does not stop me from eating fast food. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 12. I think changing my fast food eating amount for health reasons would be hard. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 13. I can change my fast food eating amount, if I learn how to quickly prepare a simple meal. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 14. I think fast food has a lot of calories. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 15. I think fast food is not good for my health. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 16. I want to learn more about nutritious foods. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 17. I plan to eat fast food more than three times this week. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree 18. I plan to eat more home prepared meals this week. a. 1-completely agree b. 2-somewhat agree c. 3-somewhat disagree d. 4-completely disagree

44

45

46

47

Be aware of portion size Choose grilled over fried TOP 5 HEALTHY FAST FOOD MEALS

It is okay to special order

Chick-fil-A: Grilled chicken sandwich with a fruit cup 400 calories, 3.5 g fat, 65 g carbs, 6 g fiber, 30 g protein Wendy’s: Chili-topped potato 460 calories, 6 g fat, 80 g carbs, 12 g fiber, 21 g protein KFC: Grilled chicken breast with mashed potatoes, and corn on the cob 430 calories, 10 g fat, 49 g carbs, 5 g fiber, 41 g protein Jack in the Box: Chicken teriyaki bowl 585 calories, 6 g fat, 106 g carbs, 4 g fiber, 25 g protein McDonalds: Southwest salad with a fruit and yogurt parfait 480 calories, 11 g fat, 61 g carbs, 7 g fiber, 34 g protein

“Healthy” dishes are not always the healthiest Say no to “super-sizing” Be wise choosing sides Drink zero-calorie beverages Opt out of condiments & dressings If you must, order them on the side

48

Program Survey 1. Did you enjoy H.A.T.E Fast Food? a. Yes b. No 2. What was your favorite session? a. First b. Second c. Third 3. Why was this your Favorite session? a. __________________________________ 4. What could we add or remove to make this program more enjoyable? a. ___________________________________ 5. Will you use what you learned in this program to educate your friends and family? a. Yes b. No c. If the situation arises

49

50

References Allison C. Sylvetsky, Monique Hennink, Dawn Comeau, et al., “Youth Understanding of Healthy Eating and Obesity: A Focus Group Study,” Journal of Obesity, vol. 2013, Article ID 670295, 6 pages, 2013. doi:10.1155/2013/670295. Dave, J. M., An, L. C., Jeffery, R. W., & Ahluwalia, J. S. (2009). Relationship of attitudes toward fast food and frequency of fast‐food intake in adults. Obesity, 17(6), 11641170. FASEB J, 24 April 2010. Copyright © 2014 by the Federation of American Societies for Experimental Biology. Harnack, L. J., French, S. A., Oakes, J. M., Story, M. T., Jeffery, R. W., & Rydell, S. A. (2008). Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial. International Journal of Behavioral Nutrition and Physical Activity, 5(1), 63. Harvard Prevention Research Center. Where and Why are Youth Eating Fast Food? https://www.hsph.harvard.edu/wpcontent/uploads/sites/84/2012/11/ytf_03_04_presentation_fast_food.pdf International Journal of Engineering and Science. 5 February, 2013. Prevalence of fast food intake among urban adolescent students. McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, Implementing, and Evaluating Health Promotion Programs: A Primer(6th ed.). San Francisco: Pearson Benjamin Cummings.

51

Neumark-Sztainer D., Story M., Hannan PJ., Perry CL., Irving LM. Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders. Archives of Pediatrics and Adolescent Medicine. 2002; 156:171-178. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States. (2009– 2010). NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics. 2012. Pereira, M., Kartashov, A., Ebbeling, C., Van Horn, L., Slattery, M., Jacobs Jr, D., Ludwig, D. (2005). Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15year prospective analysis. The Lancet, Volume 365, Issue 9453, Pages 36–42 Sebastian RS, Goldman JD, Wilkinson Enns C. Snacking Patterns of U.S. Adolescents: What We Eat In America, NHANES 2005-2006. Food Surveys Research Group Dietary Data Brief No. 2. September 2010. Available from: http://ars.usda.gov/Services/docs.htm?docid=19476. Seo, H. S., Lee, S. K., & Nam, S. (2011). Factors influencing fast food consumption behaviors of middle-school students in Seoul: an application of theory of planned behaviors. Nutrition research and practice, 5(2), 169-178. Unger, J. B., Reynolds, K., Shakib, S., Spruijt-Metz, D., Sun, P., & Johnson, C. A. (2004). Acculturation, physical activity, and fast-food consumption among AsianAmerican and Hispanic adolescents. Journal of community health, 29(6), 467481.

52